Health Care Hyde Park (1)

My Comment on the progress or non-progress of health insurance reform through the legislative meat grinder has drawn quite a few unusually intelligent and/or impassioned responses via our letters-to-the-editor e-mail box. I’m going to share a few of them on this blog, along with my responses to the responses. (A blogger always gets the last word on his or her own blog.)

Referring to the American constitutional system in his Comment, “Second Opinions,” Hendrik Hertzberg claims that “these perverse (if time-honored) institutional arrangements… are the principal cause of America’s sad health-care exceptionalism.” This argument is well-worn: nothing substantial can be accomplished in American politics because of the numerous “veto points” inherent in our institutions which allow special interests to thwart legislation virtually at will.

However, these veto points seemed non-existent when, say, the USA Patriot Act, NAFTA, tax cuts for the wealthy, and much of the so-called “Contract with America” were signed into law, despite great public and institutional opposition to each of these legislative packages. It isn’t that we can’t pass laws; we simply have trouble passing those laws that would benefit the commonwealth at the expense of the rich and powerful. The American system of checks and balances worked fine when we enacted the New Deal, Roosevelt-era antitrust legislation, and the Civil Rights Act of 1964. In light of this evidence, we must ask ourselves: What has changed since the nineteen-sixties that has made passing socially-oriented legislation nearly impossible? It seems to me that it is not the “system” which is at fault, but the overwhelming economic power that is concentrated in far too few hands. If we are to blame anything for our current woes, then, let us point the finger at those institutions that are truly guilty: America’s hopelessly bloated and ethically bankrupt corporations.

David ZoncaBrooklyn

The ease with which bills are passed that benefit rich, well-organized, narrow special interests at the expense of the amorphous commonwealth (e.g., the Bush tax cuts) and the ease with which bills are scuttled or gutted that benefit the amorphous commonwealth at the expense of rich, etc., special interests (e.g., expanded health care) are two sides of the same coin. The veto points were not nonexistent when the Bush tax cuts were passed; they were right there, but they were serving as what might be called passage points.

There’s a confusion here of moral and analytic language. Our ramshackle, eighteenth-century political system, on the one hand, and excessive, greedy corporate power, on the other, are not mutually exclusive explanations. I tend to think the former is the chicken and the latter the egg. Greedy, powerful people in the present, however, can be deemed “guilty” in a way that the neophyte constitution-makers at Philadelphia in 1789 cannot. The Framers did not intend to make it easy for the top executives of big insurance companies to enrich themselves by designing mechanisms to avoid paying for people’s medical care. (Although, to be unfair, they did intend—or, to be less unfair, they were forced to agree to mechanisms that had this effect—to make it essentially impossible for slavery to be abolished. Some of these mechanisms, such as the rule of two senators per state regardless of population, remain, in their not-very-much-changed modern form, the insurance industry’s best friends and the hapless patient’s worst enemies.)

There’s a tendency to over-romanticize the achievements of the New Deal and the Great Society. Yes, we got guaranteed (if not very generous) pensions for the aged, but we have yet to get the other part of F.D.R.’s vision of “social security”: basic, universal health insurance. Yes, we got the Civil Rights Act of 1964, which was a wonderful thing, but ninety-nine years, the time that had elapsed since Appomattox, was kind of a long time to wait, no?

Hendrik Hertzberg is a senior editor and staff writer at The New Yorker. He regularly blogs about politics.

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